Employee Referral Collection Request - 2023
Please fill this form to book your sample collection. For any questions, please reach out to us at  +918882899999 or coresponse@corediagnostics.in
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Pincode *
Employee Code *
E0XXX / C0XXX
Date of Collection
MM
/
DD
/
YYYY
Patient Mobile Number
 *
Patient Name and Address
Any other details you want to share, please add here as a remark
Please select the Test(s) required *
Required
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